which belong to it. If prompt and energetic measures be enforced at the first appearance of the disease, its spread can be cut short, as before stated, and when this has occurred on vessels coming from Europe, it has been found practicable to allow the vessels, passengers, and crew to proceed to the city with only such delay as has been required to definitely ascertain the facts, and to perform disinfection. A vessel arriving, however, with cholera on board, the same precautionary measures are carried out as are enforced on the arrival of ships with yellow fever, and eight days after the occurrence of the last case, the passengers are allowed to leave. While the foregoing measures are necessary at New York, England wisely confines her supervision of cholera, from without, to the removal and care of the sick, and the cleansing of the vessel. It would be futile for England to quarantine against ports of the continent, with which she is in daily communication. Mr. Simon has truly said that "contraband of quarantine, like ordinary smuggling, is developed so soon as the inducements for it are considerable. Yellow fever is less liable to find lodgment in England than in Spain and Portugal, or in New York.

As it is the custom for many emigrants, bound for America from the continent of Europe, to embark at Liverpool or other healthy ports, when cholera prevails on the continent, this country is exposed to the introduction of the disease through the personal effects of such emigrants, sailing on healthy vessels from healthy ports. In a recent report to Congress, I called attention to the necessity for "prompt and authoritative information to threatened ports [of the United States] of the shipment of passengers or goods from a cholera-infected district," and suggested that the consular officers of the government should be instructed to place themselves in communication with the health-authorities of their respective localities, and to advise promptly, by cable, of the outbreak of cholera, and the sailing and destination of any vessels carrying passengers and goods from infected districts. By this plan (which the Honorable Secretary of State deems it practicable to carry into effect, if Congress provide the necessary means) the thorough disinfection of infected articles would be insured, and the danger from this source of infection would be lessened.

In considering the value and practice of disinfection, the fact should be kept in view that disinfectants are not as much needed as is cleanliness: where the latter prevails, the former are not required. It is when there is not time to get rid of filth, or when the poison has found lodgment, that disinfectants are applicable, and then their application should be thorough. The value of the several disinfectants is recognized, but their use on ships depends chiefly upon the manner of application. Ordinary fumigation cannot be relied upon to destroy the poison of an infected vessel, without removing the cargo, as has been exemplified in many instances, notably in the case of the bark Valparaiso, before cited. Dr. Perry has devised an apparatus, which he used successfully at the New Orleans quarantine, in 1874, whereby either sulphurous-acid gas, carbolicacid vapor, or heated air, can be forced into a ship through flexible rubber pipes, by means of blowers propelled by steain, all hatches and other openings in the ship having been first securely closed. Whether

Effectual External Sanitary Regulations without Delay to Commerce. By A. W. Perry, M.D., of New Orleaus. American Public-Health Association's Reports and Papers, vol. i. p. 437.

this process, in which are employed from thirty to one hundred pounds of sulphur, for a single vessel, will always prove effectual without removing the ship's cargo, remains to be determined by further trial.

It must be admitted that the germs of infectious diseases may elude the most vigilant sanitary supervision of shipping which can be devised; hence the importance of municipal co-operation, to the end that all exposed cities may, through wisely directed sanitary measures, be rendered less susceptible of infection. The value of sanitary supervision of ocean-travel and traffic, and of preventive measures at home, is more and more recognized by civilized nations, and the enlightened and vigorous prosecution of these means gives hope of rendering exposed countries less liable to infection; but the repeated battles against cholera and yellow fever should awaken an international spirit, and a determination to carry the war upon these diseases to their endemic homes, and to there instruct the people, and if need be compel them, to employ rational means of prevention.

From what has preceded, the following conclusions appear to be justi

fied:

I. The supervision of ocean-travel ought to be directed to securing good sanitary conditions for vessels at all times, out of as well as in port. II. A system of Port-Sanitation should be adopted and administered for each country or place, separately, and should be modified in particular cases by taking into account the liability of the port to infection, the period of incubation of the disease, the length of time consumed in the voyage, and the measures enforced by the vessel en route.

III. In some countries, the detention of passengers and crews of ships hailing from infected ports is warranted, but for such time only as is necessary to complete the period of incubation of cholera or of yellow fever, counting from the date of departure from an infected port, or of landing from an infected vessel; in no instance should passengers or sailors be held for observation on board an infected vessel, and such vessel should not be detained beyond the period required for inspection, and for thorough disinfection and cleansing.

IV. Recognizing the fact that the morbific causes of infectious diseases may sometimes elude the most vigilant sanitary supervision of shipping, the importance of wisely directed internal sanitary measures can scarcely be overestimated.

V. As far as America is concerned, it is desirable that prompt and authoritative information should be had of the shipment of passengers or goods from districts infected with cholera or yellow fever, thereby insuring the thorough disinfection of infected articles.

VI. The endemic homes of cholera and yellow fever are the fields. which give the greatest promise of satisfactory results to well-directed and energetic sanitary measures, and to this end an international sentiment should be awakened, so strong as to compel the careless and offending people to employ rational means of prevention.

DISCUSSION ON DR. WOODWORTH'S PAPER.

After the reading of the preceding paper, Dr. A. S. BALDWIN, of Jacksonville, Florida, said:-In the port where I have lived for the last thirty years, there has been no visitation of yellow fever as an epidemic.

Isolated cases

have presented themselves, but there has been no spread. In one instance, the disease was brought in the contents of a valise. A gentleman, a resident of that section of country, had been visiting in Havana, and in the course of his rambles had passed through the Yellow-Fever Hospital. In a valise, which he had opened two or three times on the way, the disease was carried, and affected a nephew and niece who met him on his return. The niece recovered. but the nephew died, and a post-mortem examination showed the liver to be of a boxwood color. No other case of yellow fever followed from that outbreak. In 1857, a disease broke out in Jacksonville, supposed to be yellow fever, but it could not be traced to any foreign cause, and it differed somewhat in its symptoms. During the summer a marsh had been cut off, and a railroad depot erected thereon. This was in June. On the 20th of August, an individual living near the marsh was affected with a fever; on the 20th of September, the disease was still existing in that neighborhood, and had occasioned much alarm, 100 deaths having resulted. But the fever was as unlike the cases of yellow fever which have been brought to Jacksonville, as typhoid fever is unlike typhus.

Dr. HENRY HARTSHORNE, of Haverford College, Pennsylvania, said:-If we believe that yellow fever is not personally communicable, there should be no detention of the sick at quarantine. In regard to cholera, the fact mentioned in the paper that persons escape by fleeing from the disease, is a proof that it is not more communicable than yellow fever. Efforts to disinfect the stools of patients have notoriously failed to arrest the disease, while local sanitary regulations have in this country prevented its spread. Quarantine and detention have caused many deaths on infected vessels. What is wanted, is to do away with personal detention at quarantine, and to see that sanitation is enforced at sea and in port. A comparison has shown that rigid restrictions have failed in Pensacola, while, in New York, less rigid restrictions have been attended with better results.

Dr. S. OAKLEY VANDERPOEL, of New York, said:-There are three distinct schools of belief, as to quarantine: One relies wholly upon a certain amount of detention, and with another, everything depends on cleanliness, following out the English hygienic system by which quarantine has been done away with. I think that the modern school is the best, which employs a combination of moderate detention and sanitation. I am willing to go as far as any one in praise of local sanitation, but there is a necessity for the detention of vessels coming from infected ports. I say too that yellow fever is not contagious, from person to person, but I think that persons should be detained until the period of incubation of the disease has passed. In New York there is no quarantine, that is to say, no forty days' detention, as the name implies; there may be a delay of a couple of days, but the period of incubation must be allowed to elapse before passengers' baggage and clothing are permitted to go into the city. There have been several instances in France in which disease has been carried away to the country in clothing. A Savannah steamer came into New York Harbor last Sunday morning. The crew and passengers were perfectly well, and the vessel had not been lying in that portion of the town in which the epidemic was raging, but I held the vessel twenty-four hours, to make up the five days out. I do not call that a quarantine. Quarantine has killed more persons than it has saved. The epidemic in New York, in 1856, was caused by the Health Officers placing a vessel with its cargo off Long Island. Exposed to the sun, and lying there for twenty days, it became a pest-ship, and soon from 150 to 200 vessels were strung along the Long Island coast, all infected. Clothing and offal were thrown overboard from these, and people living within two or three miles of the coast suffered. In relation to cholera, I believe that if the dejections can be disposed of immediately, the risk of contagion can be prevented. There is a period of from one and a half to two hours, in which the dejections are inert; after that, fermentation sets in, and they become contagious. As far as I have been able to study the subject,

cholera can be traced along the lines of travel. Even with the same atmospheric conditions, five or ten miles from the line of travel, the disease is not found. There are seasons in which epidemics are intense, and others in which, if proper sanitary precautions be taken, cholera, though breaking out with great virulence, will last only a week or ten days.

Dr. J. G. KERR, of San Francisco, said:-In the cities of China there are no municipal governments, and no arrangements are made for cleaning the streets. The filth which accumulates remains in the streets until carried off by natural processes, or carted off by scavengers. Some streets are filled the whole year with filth. I witnessed two epidemics of cholera in China, but they did not seem to be influenced by the filth, nor confined to the filthy sections. Why is this, when so much stress is placed in America and in Europe on cleanliness? My own opinion is, that it is due to the absence of underground sewerage. In the cities of China there is no system of underground drainage, and the gases which form are not confined. Epidemics there are not worse than here. The poisons which propagate these are fostered by the arrangement of drainage here, and fermentation in sewers is as much to blame as anything else. In China, where no attention is paid to drainage, there is no confinement of gases, and no concentration of influences which produce disease. My observations were confirmed by a physician of the British Army, who, during the Chinese war of 1856-1857, visited cities where the accumulations of filth were obnoxious to strangers.

Dr. HARTSHORNE said:-It can be easily seen that scattered filth is not as poisonous as when it is concentrated, but the fact still remains that filth is one of the factors of disease. If it be true that the period of incubation of cholera is short, yet I have known cases in which cholera has appeared when a vessel has been two weeks at sea. The morbific agent which produces cholera has met a vessel out at sea, and though the ship has been detained in quarantine, yet in all that time the disease has not passed to the cabin-passengers, showing that it is connected with local conditions and migratory causes.

Dr. VANDERPOEL said:-I agree with Dr. Hartshorne that cholera has appeared in vessels hailing from perfectly healthy ports, but inquiry has shown that the steerage-passengers, among whom the disease has broken out, did not belong to the port from which they started. For instance, most emigrants to this country start from Liverpool, yet they belong to Poland and other places. These outbreaks on vessels have thus been traced to sections in which the disease has been raging. In the clothing of these emigrants, there is undoubtedly a large quantity of soiled linen, which, as is well known, carries the disease. The fact of the vessel coming from a healthy port does not show that every one on board belongs to the healthy port. I can account for what Dr. Hartshorne has related, by the baggage being closed until the vessel has got out to sea; case after case has been traced to trunks. That is one reason why the disease does not go among the cabin-passengers; steerage-passengers generally keep their baggage about them, while cabin-passengers have their trunks stored in the hold, and there they remain until the end of the voyage. Besides, the cabin-passengers are more cleanly, which is another point in favor of Dr. Hartshorne's idea of sanitation.

Dr. EZRA M. HUNT, of Metuchen, New Jersey, said :-I remember a case in which a lady visited a hospital, and three weeks afterwards wore the same silk dress which she had worn while at the hospital. Scarlet fever broke out immediately afterwards. As to filth, we have never yet had it proved to originate cholera. We understand that filth is a nest for disease, some of which it does, and some of which it does not, originate; and this is a good reason why we should get rid of it. The fact that it does not originate cholera and yellow fever, does not weaken the importance of not letting their contagia get into the filth. To prevent the spread of these diseases, we must stop baggage and disinfect vessels, and stop passengers too, if necessary, but not keep them on the ships.

A UNIVERSAL PHARMACOPOEIA.

BY

EDWARD R. SQUIBB, M.D.,

OF BROOKLYN.

THE idea of an International or Universal Pharmacopoeia, though by no means new, has within a few years past come before the medical and pharmaceutical professions with more than ordinary prominence, and much has been written on the subject. The rate of progress in the art of medicine in its utility to mankind, depends largely upon accumulated experience; experience is the result of research and observation; and the value of an observation is in direct proportion to its accuracy and completeness. That classification and comparison of observations, the result of which is experience in the art, depends largely for its value upon the uniformity of the conditions under which the observations are made, and hence the present strong tendency to control and to formulate the conditions under which experience accumulates, so that a larger proportion of it may take the rank of absolute knowledge. For example, we know, as the result of observation which has passed through the stage of experience to become absolute knowledge, that opium relieves pain. This reaction between opium and pain involves two distinct series of phenomena, or is conditioned from two separate bases: First, the cause, nature, and quantity of pain, and this concerns the pathologist; and, second, the cause, nature, and quantity of the opium appropriate to the reaction, and this concerns the therapeutist. Pain is universal. Opium has, through knowledge. become almost universal. To formulate and condition the opium for this reaction upon the best results of general experience in the past, so that future experience may accumulate under uniform conditions of the medicinal agent and may accumulate universally to the same single end, namely, advanced knowledge for universal good-is the object sought for in a Universal Pharmacopoeia.

Some such train of reasoning as this, having for its basis, at least, the establishment of a universal standard of strength, composition, and quality, for medicinal agents, so that by accuracy in the agents the results of their use all over the world may be compared with accuracy, and thus more rapidly convert empirical experience into knowledge, has been generally advanced in support of the design. And it may be said that the same line of argument, and the same necessities which made National Pharmacopoeias first useful, and then indispensable, must, with the advance of civilization, apply with equal force to produce an International Pharmacopoeia. Thus the advantages to be expected from a Universal Pharmacopoeia are so great and so easily shown, and the arguments for it are so forcible, that up to this time all writers upon the subject, as far as seen, in all nations, have been on one side of the question. And yet, although ranged on the same side of the question, I have, by thoughtful consideration of the subject, gradually reached the conclusion that the design is premature, and for the present age impracticable, for the following principal reasons: